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Goddard A, Jones R, Etcher L. Trauma informed care in nursing: A concept analysis. Nurs Outlook 2022; 70:429-439. [DOI: 10.1016/j.outlook.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/18/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
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Parker D, Byng R, Dickens C, McCabe R. Patients' experiences of seeking help for emotional concerns in primary care: doctor as drug, detective and collaborator. BMC FAMILY PRACTICE 2020; 21:35. [PMID: 32059636 PMCID: PMC7020382 DOI: 10.1186/s12875-020-01106-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/05/2020] [Indexed: 11/24/2022]
Abstract
Background NICE guidelines for the management of emotional concerns in primary care emphasise the importance of communication and a trusting relationship, which is difficult to operationalise in practice. Current pressures in the NHS mean that it is important to understand care from a patient perspective. This study aimed to explore patients’ experiences of primary care consultations for emotional concerns and what patients valued when seeking care from their GP. Methods Eighteen adults with experience of consulting a GP for emotional concerns participated in 4 focus groups. Data were analysed thematically. Results (1) Doctor as Drug: Patients’ relationship with their GP was considered therapeutic with continuity particularly valued. (2) Doctor as Detective and Validator: Patients were often puzzled by their symptoms, not recognising their emotional concerns. GPs needed to play the role of detective by exploring not just symptoms, but the person and their life circumstances. GPs were crucial in helping patients understand and validate their emotional concerns. (3) Doctor as Collaborator: Patients prefer a collaborative partnership, but often need to relinquish involvement because they are too unwell, or take a more active role because they feel GPs are ill-equipped or under too much pressure to help. Patients valued: GPs booking their follow up appointments; acknowledgement of stressful life circumstances; not relying solely on medication. Conclusions Seeking help for emotional concerns is challenging due to stigma and unfamiliar symptoms. GPs can support disclosure and understanding of emotional concerns by fully exploring and validating patients’ concerns, taking into account patients’ life contexts. This process of exploration and validation forms the foundation of a curative, trusting GP-patient relationship. A trusting relationship, with an emphasis on empathy and understanding, can make patients more able to share involvement in their care with GPs. This process is cyclical, as patients feel that their GP is caring, interested, and treating them as a person, further strengthening their relationship. NICE guidance should acknowledge the importance of empathy and validation when building an effective GP-patient partnership, and the role this has in supporting patients’ involvement in their care.
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Affiliation(s)
- Daisy Parker
- College of Medicine and Health, University of Exeter, Exeter, UK.
| | | | - Chris Dickens
- College of Medicine and Health, University of Exeter, Exeter, UK
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Poleshuck E, Wittink M, Crean HF, Juskiewicz I, Bell E, Harrington A, Cerulli C. A Comparative Effectiveness Trial of Two Patient-Centered Interventions for Women with Unmet Social Needs: Personalized Support for Progress and Enhanced Screening and Referral. J Womens Health (Larchmt) 2019; 29:242-252. [PMID: 31502906 DOI: 10.1089/jwh.2018.7640] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Despite recent widespread acceptance that unmet social needs are critically relevant to health, limited guidance exists about how best to address them in the context of women's health care delivery. We aimed to evaluate two interventions: enhanced screening and referral (ESR), a screening intervention with facilitated referral and follow-up calls, and personalized support for progress (PSP), a community health worker intervention tailored to women's priorities. Materials and Methods: Women >18 years were screened for presence of elevated depressive symptoms in three women's health clinics serving primarily Medicaid-eligible patients. If eligible and interested, we enrolled and randomized women to ESR or PSP. Pre- and postintervention assessments were conducted. Primary outcomes were satisfaction, depression, and quality of life (QOL). Planned analyses of subgroup differences were also explored. Results: A total of 235 participants were randomized; 54% identified as African American, 19% as White, and 15% as Latina. Participant mean age was 30 years; 77% reported annual incomes below US $20,000/year; and 30% were pregnant at enrollment. Participants in both arms found the interventions satisfactory and improved for depression (p < 0.001). There were no differences between groups for the primary outcomes. Subgroups reporting greater improvement in QOL in PSP compared with ESR included participants who at baseline reported anxiety (p = 0.05), lack of access to depression treatment (p = 0.02), pain (p = 0.04), and intimate partner violence (p = 0.02). Conclusions: Clinics serving women with unmet social needs may benefit from offering PSP or ESR. Distinguishing how best to use these interventions in practice is the next step.
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Affiliation(s)
- Ellen Poleshuck
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.,Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Marsha Wittink
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.,Department of Family Medicine, University of Rochester Medical Center, Rochester, New York
| | - Hugh F Crean
- School of Nursing, University of Rochester, Rochester, New York
| | - Iwona Juskiewicz
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Elaine Bell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Amy Harrington
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Catherine Cerulli
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.,Susan B. Anthony Center, University of Rochester, Rochester, New York
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Hammer JH, Perrin PB, Spiker DA. Impact of integrated care and co-location of care on mental help-seeking perceptions. J Ment Health 2019; 30:405-410. [PMID: 30862218 DOI: 10.1080/09638237.2019.1581334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Integrated care may offer a solution to subpar mental health referral adherence, but people's openness to receiving psychological treatment in this setting is understudied. AIMS The present study examined the influence of the integrated care context and co-location of care on people's help-seeking perceptions. METHOD This study (N = 397) used an experimental vignette design to compare the impact of treatment type (integrated care vs. traditional psychotherapy) and distance (close vs. far) on help-seeking perceptions. RESULTS The integrated care environment (significant effect on perceived behavioral control) and closer proximity of the psychologist (significant effect on intention, attitudes, perceived effectiveness of treatment, self-stigma) only improved help-seeking perceptions among those with prior experience with mental health treatment. In the overall sample, treatment type and distance only demonstrated an effect among women, but not men. CONCLUSIONS Pending replication with samples from diverse populations, these findings provide a cautionary tale about lay perceptions of integrated care's anticipated utility. However, co-location and, to a lesser degree, the common attributes of the integrated care format (e.g. team approach, flexible scheduling) may represent a potential pathway for reducing resistance to help seeking that can accompany traditional psychotherapy referrals among those with past exposure to behavioral healthcare.
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Affiliation(s)
- Joseph H Hammer
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Paul B Perrin
- Psychology Department, Virginia Commonwealth University, Richmond, VA, USA
| | - Douglas A Spiker
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
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Hammer JH, Spiker DA, Perrin PB. Physician referral to a psychologist: Testing alternative behavioral healthcare seeking models. J Clin Psychol 2018; 75:726-741. [PMID: 30552683 DOI: 10.1002/jclp.22729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Primary care physicians (PCPs) often refer patients to psychological services, but help-seeking factors in the context of behavioral healthcare referral are understudied. This study examined perceptions of seeking psychological help for depression by comparing alternative structural equation models derived from the Theory of Reasoned Action (TRA). METHOD Internet survey participants (N = 685 US adults, 77% female, M age = 45) imagined themselves in a vignette scenario in which they are experiencing depression symptoms and encouraged by a PCP to see a psychologist. RESULTS Results supported the indirect model, in which the links between distal help-seeking factors (i.e., self-stigma, symptom recognition, perceived effectiveness of treatment) and intention to follow through on the referral to the psychologist were fully mediated by the more proximal TRA factors (i.e., attitudes, subjective norms, etc). CONCLUSIONS Our findings supported the use of TRA in understanding peoples' intention to seek psychological help for depression when referred by their PCP.
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Affiliation(s)
- Joseph H Hammer
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, Kentucky
| | - Douglas A Spiker
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, Kentucky
| | - Paul B Perrin
- Psychology Department, Virginia Commonwealth University, Richmond, Virginia
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Chen S, Conwell Y, Cerulli C, Xue J, Chiu HFK. Primary care physicians' perceived barriers on the management of depression in China primary care settings. Asian J Psychiatr 2018; 36:54-59. [PMID: 29966887 PMCID: PMC6173978 DOI: 10.1016/j.ajp.2018.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 05/28/2018] [Accepted: 06/26/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chinese patients with depression have limited access to mental health specialty care because of myriad barriers at different levels. Recently, there has been increased interest in targeting primary care settings for managing depression, because most depressed individuals visit their primary care physicians (PCPs) during the course of their depressive episodes. The present study examined PCPs' perceived barriers on the management of depression. METHODS A total of 295 PCPs completed a 36-item survey by mail. The survey questions included demographics, years in primary care, mental health training experience, and perceived barriers regarding the management of depression in their clinical and current practices. Chi-square and t-test analyses were used to compare the difference of demographic variables between the two districts. For the correlates of PCPs' clinical practices and their perceived barriers, logistic regression models were used. RESULTS At the practice level, lack of access to mental health specialists (37.8%) was the most commonly reported barrier and at patients' level, reluctance toward diagnosis of depression (34.6%) was the high barrier. Results have indicated that most PCPs (69.2%) felt comfortable discussing psychological issues with patients. Mental health training is significantly related to PCPs' clinical practice. When PCPs perceived moderate to high-level practice level barriers, prescription and referral were mostly preferred. CONCLUSION PCPs in China perceived some barriers in the management of depression, but they were open to modifications and enhancement of their skills related to managing depression.
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Affiliation(s)
- Shulin Chen
- Department of Psychology, Zhejiang University, China.
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, USA
| | - Catherine Cerulli
- Department of Psychiatry, University of Rochester Medical Center, USA
| | - Jiang Xue
- Department of Psychology, Zhejiang University, China
| | - Helen F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, China
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Hines AL, Roter D, Ghods Dinoso BK, Carson KA, Daumit GL, Cooper LA. Informed and patient-centered decision-making in the primary care visits of African Americans with depression. PATIENT EDUCATION AND COUNSELING 2018; 101:233-240. [PMID: 28779910 PMCID: PMC5785566 DOI: 10.1016/j.pec.2017.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We examined the prevalence and extent of informed decision-making (IDM) and patient-centered decision-making (PCDM) in primary care visits of African Americans with depression. METHODS We performed a cross-sectional analysis of audiotaped clinical encounters and post-visit surveys of 76 patients and their clinicians. We used RIAS to characterize patient-centeredness of visit dialogue. IDM entailed discussion of 3 components: the nature of the decision, alternatives, and pros/cons. PCDM entailed discussion of: lifestyle/coping strategies, knowledge/beliefs, or treatment concerns. We examined the association of IDM and PCDM with visit duration, overall patient-centeredness, and patient/clinician interpersonal ratings. RESULTS Approximately one-quarter of medication and counseling decisions included essential IDM elements and 40% included at least one PCDM element. In high patient-centered visits, IDM was associated with patients feeling respected in counseling and liking clinicians in medication decisions. IDM was not related to clinician ratings. In low patient-centered visits, PCDM in counseling decisions was positively associated with patients feeling respected and clinicians respecting patients. CONCLUSIONS The associations between IDM and PCDM with interpersonal ratings was moderated by overall patient-centeredness of the visit, which may be indicative of broader cross-cultural communication issues. PRACTICE IMPLICATIONS Strengthening partnerships between depressed African Americans and their clinicians may improve patient-engaged decision-making.
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Affiliation(s)
- Anika L Hines
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Debra Roter
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kathryn A Carson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gail L Daumit
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Yasui M, Pottick KJ, Chen Y. Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families. Clin Child Fam Psychol Rev 2017; 20:250-332. [PMID: 28275923 PMCID: PMC5614708 DOI: 10.1007/s10567-017-0229-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite the central role culture plays in racial and ethnic disparities in mental health among ethnic minority and immigrant children and families, existing measures of engagement in mental health services have failed to integrate culturally specific factors that shape these families' engagement with mental health services. To illustrate this gap, the authors systematically review 119 existing instruments that measure the multi-dimensional and developmental process of engagement for ethnic minority and immigrant children and families. The review is anchored in a new integrated conceptualization of engagement, the culturally infused engagement model. The review assesses culturally relevant cognitive, attitudinal, and behavioral mechanisms of engagement from the stages of problem recognition and help seeking to treatment participation that can help illuminate the gaps. Existing measures examined four central domains pertinent to the process of engagement for ethnic minority and immigrant children and families: (a) expressions of mental distress and illness, (b) causal explanations of mental distress and illness, (c) beliefs about mental distress and illness, and (d) beliefs and experiences of seeking help. The findings highlight the variety of tools that are used to measure behavioral and attitudinal dimensions of engagement, showing the limitations of their application for ethnic minority and immigrant children and families. The review proposes directions for promising research methodologies to help intervention scientists and clinicians improve engagement and service delivery and reduce disparities among ethnic minority and immigrant children and families at large, and recommends practical applications for training, program planning, and policymaking.
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Affiliation(s)
- Miwa Yasui
- School of Social Service Administration, University of Chicago, 969 E 60th St, Chicago, IL, 60637, USA.
| | - Kathleen J Pottick
- School of Social Work and Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, 112 Paterson St, New Brunswick, NJ, 08903, USA
| | - Yun Chen
- School of Social Service Administration, University of Chicago, 969 E 60th St, Chicago, IL, 60637, USA
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Haddad M, Waqas A, Sukhera AB, Tarar AZ. The psychometric characteristics of the revised depression attitude questionnaire (R-DAQ) in Pakistani medical practitioners: a cross-sectional study of doctors in Lahore. BMC Res Notes 2017; 10:333. [PMID: 28750688 PMCID: PMC5530926 DOI: 10.1186/s13104-017-2652-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background Depression is common mental health problem and leading contributor to the global burden of disease. The attitudes and beliefs of the public and of health professionals influence social acceptance and affect the esteem and help-seeking of people experiencing mental health problems. The attitudes of clinicians are particularly relevant to their role in accurately recognising and providing appropriate support and management of depression. This study examines the characteristics of the revised depression attitude questionnaire (R-DAQ) with doctors working in healthcare settings in Lahore, Pakistan. Methods A cross-sectional survey was conducted in 2015 using the revised depression attitude questionnaire (R-DAQ). A convenience sample of 700 medical practitioners based in six hospitals in Lahore was approached to participate in the survey. The R-DAQ structure was examined using Parallel Analysis from polychoric correlations. Unweighted least squares analysis (ULSA) was used for factor extraction. Model fit was estimated using goodness-of-fit indices and the root mean square of standardized residuals (RMSR), and internal consistency reliability for the overall scale and subscales was assessed using reliability estimates based on Mislevy and Bock (BILOG 3 Item analysis and test scoring with binary logistic models. Mooresville: Scientific Software, 55) and the McDonald’s Omega statistic. Findings using this approach were compared with principal axis factor analysis based on Pearson correlation matrix. Results 601 (86%) of the doctors approached consented to participate in the study. Exploratory factor analysis of R-DAQ scale responses demonstrated the same 3-factor structure as in the UK development study, though analyses indicated removal of 7 of the 22 items because of weak loading or poor model fit. The 3 factor solution accounted for 49.8% of the common variance. Scale reliability and internal consistency were adequate: total scale standardised alpha was 0.694; subscale reliability for professional confidence was 0.732, therapeutic optimism/pessimism was 0.638, and generalist perspective was 0.769. Conclusions The R-DAQ was developed with a predominantly UK-based sample of health professionals. This study indicates that this scale functions adequately and provides a valid measure of depression attitudes for medical practitioners in Pakistan, with the same factor structure as in the scale development sample. However, optimal scale function necessitated removal of several items, with a 15-item scale enabling the most parsimonious factor solution for this population.
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Affiliation(s)
- Mark Haddad
- Centre for Mental Health Research; School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK. .,East London NHS Foundation Trust, London, UK.
| | - Ahmed Waqas
- CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
| | | | - Asad Zaman Tarar
- CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
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Athié K, Dowrick C, Menezes ALDA, Cruz L, Lima AC, Delgado PGG, Favoretto C, Fortes S. Anxious and depressed women's experiences of emotional suffering and help seeking in a Rio de Janeiro favela. CIENCIA & SAUDE COLETIVA 2017; 22:75-86. [PMID: 28076531 DOI: 10.1590/1413-81232017221.11732016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 08/12/2016] [Indexed: 12/14/2022] Open
Abstract
Taking into consideration issues such as stigma and the mental health gap, this study explores narratives of anxious and depressed women treated in a community-based primary care service in a Rio de Janeiro favela about their suffering and care. We analysed 13 in-depth interviews using questions from Kadam's study. Framework analysis studied Access, Gateway, Trust, Psychosocial Issues, and Primary Mental Health Care, as key-concepts. Vulnerability and accessibility were the theoretical references. Thematic analysis found "suffering category", highlighting family and community problems, and "help seeking category", indicating how these women have coped with their emotional problems and addressed their needs through health services, community resources and self-help. Women's language patterns indicated links between implicit social rules and constraints to talk about suffering, especially if related to local violence. High medical turnover and overload are barriers for establishing a positive relationship with family physicians and continuity of care is a facilitator that promotes trust, security and adherence. Concluding, to plan community-based primary mental health care of this population, cultural and social factors must be comprehended as well as the work health teams conditions.
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Affiliation(s)
- Karen Athié
- Laboratório Interdisciplinar de Pesquisa em Atenção Primária à Saúde, Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro. Boulevard Vinte e Oito de Setembro 77, Vila Isabel. 20551-030 Rio de Janeiro RJ Brasil.
| | - Christopher Dowrick
- Institute of Psychology Health and Society, University of Liverpool. Liverpool Inglaterra
| | - Alice Lopes do Amaral Menezes
- Laboratório Interdisciplinar de Pesquisa em Atenção Primária à Saúde, Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro. Boulevard Vinte e Oito de Setembro 77, Vila Isabel. 20551-030 Rio de Janeiro RJ Brasil.
| | - Luanda Cruz
- Laboratório Interdisciplinar de Pesquisa em Atenção Primária à Saúde, Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro. Boulevard Vinte e Oito de Setembro 77, Vila Isabel. 20551-030 Rio de Janeiro RJ Brasil.
| | - Ana Cristina Lima
- Laboratório Interdisciplinar de Pesquisa em Atenção Primária à Saúde, Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro. Boulevard Vinte e Oito de Setembro 77, Vila Isabel. 20551-030 Rio de Janeiro RJ Brasil.
| | - Pedro Gabriel Godinho Delgado
- Núcleo de Políticas Públicas em Saúde Mental (NUPPSAM), Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil
| | - Cesar Favoretto
- Laboratório Interdisciplinar de Pesquisa em Atenção Primária à Saúde, Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro. Boulevard Vinte e Oito de Setembro 77, Vila Isabel. 20551-030 Rio de Janeiro RJ Brasil.
| | - Sandra Fortes
- Laboratório Interdisciplinar de Pesquisa em Atenção Primária à Saúde, Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro. Boulevard Vinte e Oito de Setembro 77, Vila Isabel. 20551-030 Rio de Janeiro RJ Brasil.
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Wisner KL, Sit DKY, McShea M, Luther JF, Eng HF, Dills JL, Moses-Kolko EL, Wisniewski SR. Telephone-Based Depression Care Management for Postpartum Women: A Randomized Controlled Trial. J Clin Psychiatry 2017; 78:1369-1375. [PMID: 28796940 PMCID: PMC7295181 DOI: 10.4088/jcp.15m10563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 10/19/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE With a period prevalence of 21.9% in the year after birth, depression is a common complication of childbearing. We assessed the impact of telephone-delivered depression care management (DCM) on symptom levels, health service utilization, and functional status 3, 6, and 12 months postpartum. METHODS The randomized controlled trial was conducted at the University of Pittsburgh, Pittsburgh, Pennsylvania, from March 2006 through September 2010. Women (N = 628) who screened positive for depression (a score of 10 or greater on the Edinburgh Postnatal Depression Scale) 4 to 6 weeks postpartum were evaluated with the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition With Psychotic Screen and enrolled in a randomized trial of DCM compared to enhanced usual care (EUC). Clinicians conducted telephone contacts to educate, assist with treatment decisions, monitor symptoms, facilitate access to services, and encourage links to community resources. Independent evaluators collected symptom scores, functional status, and health services use at 3, 6, and 12 months postpartum. Primary outcome was reduction of symptoms as measured by the Structured Interview Guide for the Hamilton Depression Rating Scale with Atypical Depression Supplement. RESULTS Mean depressive symptom and function scores significantly improved (by greater than 50%) in both groups of women but did not differ by DCM versus EUC assignment. Health services use was similar in women randomly assigned to DCM compared to EUC. Women with childhood sexual abuse responded significantly more favorably to DCM on depression and functional measures (all P values < .02). CONCLUSIONS Both DCM and EUC favorably impacted depression symptom levels and function. The subgroup of women with childhood sexual abuse benefited significantly more from DCM compared to the EUC condition. Regular telephone availability of a clinician is a resource that appears to be particularly therapeutic to women with childhood sexual abuse. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00282776.
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Affiliation(s)
- Katherine L. Wisner
- Asher Center for the Study and Treatment of Depressive Disorders, Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Northwestern University, Chicago, Illinois,Corresponding author: Katherine L. Wisner, MD, 676 N St Clair St, Ste 1000, Chicago, IL 60611 ()
| | - Dorothy K. Y. Sit
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary McShea
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - James F. Luther
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heather F. Eng
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John L. Dills
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eydie L. Moses-Kolko
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen R. Wisniewski
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Stenberg U, Haaland-Øverby M, Fredriksen K, Westermann KF, Kvisvik T. A scoping review of the literature on benefits and challenges of participating in patient education programs aimed at promoting self-management for people living with chronic illness. PATIENT EDUCATION AND COUNSELING 2016; 99:1759-1771. [PMID: 27461944 DOI: 10.1016/j.pec.2016.07.027] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/14/2016] [Accepted: 07/16/2016] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To give a comprehensive overview of benefits and challenges from participating in group based patient education programs that are carried out by health care professionals and lay participants, aimed at promoting self-management for people living with chronic illness. METHODS We searched 8 literature databases. Full text articles meeting the inclusion criteria were retrieved and reviewed. Arksey and O'Malley's framework for scoping studies guided the review process and thematic analysis was undertaken to synthesize extracted data. RESULTS Of the 5935 titles identified, 47 articles were included in this review. The participants experienced the programs as beneficial according to less symptom distress and greater awareness of their own health, improved self-management strategies, peer support, learning and hope. CONCLUSION A substantial evidence base supports the conclusion that group based self-management patient education programs in different ways have been experienced as beneficial, but more research is needed. PRACTICE IMPLICATIONS The insights gained from this review can enable researchers, health care professionals, and participants to understand the complexity in evaluating self-management patient education programs, and constitute a basis for a more standardized and systematic evaluation. The results may also encourage health care professionals in planning and carrying out programs in cooperation with lay participants.
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Affiliation(s)
- Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway; Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway.
| | - Mette Haaland-Øverby
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway.
| | - Kari Fredriksen
- Learning and Mastery Center, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway.
| | - Karl Fredrik Westermann
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway.
| | - Toril Kvisvik
- Patient Education Resource Center, Møre and Romsdal Hospital, Herman Døhlens vei 1, 6508 Kristiansund, Norway.
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Cabassa LJ. Latino Immigrant Men's Perceptions of Depression and Attitudes Toward Help Seeking. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2016. [DOI: 10.1177/0739986307307157] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Perceptions of depression, attitudes toward depression treatments, help-seeking preferences, and perceived barriers to care were examined in a sample of 56 Latino immigrant men recruited from a primary health care clinic. Each participant was presented a vignette depicting an individual with major depression. Men described the vignette as a debilitating condition caused by social stressors that would improve with time. Men preferred counseling over medications and reported misconceptions about antidepressants. Faith in God and seeking help from family members were seen as important help-seeking strategies. Structural and financial barriers were prevalent among this sample of men. Implications for improving depression care for Latino immigrant men are discussed.
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Rothschild SK, Emery-Tiburcio EE, Mack LJ, Wang Y, Avery EF, Li H, Golden RL, Powell LH. BRIGHTEN Heart: Design and baseline characteristics of a randomized controlled trial for minority older adults with depression and cardiometabolic syndrome. Contemp Clin Trials 2016; 48:99-109. [PMID: 27091813 DOI: 10.1016/j.cct.2016.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 04/03/2016] [Accepted: 04/10/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVES African American and Hispanic elderly are at elevated risk of both depression and cardiovascular disease, relative to non-Hispanic whites. Effective interventions are therefore needed to address depressive symptoms and to reduce these disparities. BRIGHTEN Heart was a behavioral randomized controlled trial to test the efficacy of a virtual team intervention in reducing depressive symptoms in minority elderly as measured by the 9-item Patient Health Questionnaire (PHQ9). STUDY DESIGN 250 African American and Hispanic adults, age ≥60 years, with comorbid depression and overweight/obesity were randomized. Participants randomized to the Intervention condition received a social work evaluation, team-based electronic consultation, case management, and psychotherapy over a 12 month period. Control participants were enrolled in a membership program that provided health classes and other services to support chronic disease self-management. Blinded research assistants completed assessments at baseline, and 6 and 12 months postrandomization. RESULTS The study population was characterized by low socioeconomic status, with 81.4% having a household income of less than $20,000. Although median depression scores were in the mild range, 25% of participants had scores showing moderate to severe depression at baseline. 75% of participants had four or more chronic conditions. Significant demographic and clinical differences were observed between the African American and Hispanic populations. CONCLUSIONS BRIGHTEN Heart was designed to rigorously test the efficacy of a multi-level intervention to reduce comorbid depressive symptoms and cardiovascular risk in minority elderly. Investigators successfully recruited a cohort well suited to testing the study hypothesis.
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Affiliation(s)
- S K Rothschild
- Departments of Preventive Medicine and Family Medicine, Rush Medical College, USA
| | | | - L J Mack
- Department of Behavioral Sciences, Rush Medical College, USA
| | - Y Wang
- Department of Preventive Medicine, Rush Medical College, USA
| | - E F Avery
- Department of Preventive Medicine, Rush Medical College, USA
| | - H Li
- Rush Alzheimer's Disease Center, Rush University Medical Center, USA
| | - R L Golden
- Health and Aging Programs, Rush University Medical Center, USA
| | - L H Powell
- Department of Preventive Medicine, Rush Medical College, USA
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Green BL, Saunders PA, Power E, Dass-Brailsford P, Schelbert KB, Giller E, Wissow L, Hurtado de Mendoza A, Mete M. Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training. JOURNAL OF LOSS & TRAUMA 2015; 21:147-159. [PMID: 27721673 DOI: 10.1080/15325024.2015.1084854] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma's effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.
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Affiliation(s)
- Bonnie L Green
- Department of Psychiatry, Georgetown University Medical School, Washington, DC, USA
| | - Pamela A Saunders
- Department of Psychiatry, Georgetown University Medical School, Washington, DC, USA ; Department of Neurology, Georgetown University Medical School, Washington, DC, USA
| | | | | | | | | | - Larry Wissow
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Mihriye Mete
- Department of Psychiatry, MedStar Health Research Institute, Hyattsville, Maryland, USA
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Adams A, Vail L, Buckingham C, Kidd J, Weich S, Roter D. Investigating the influence of African American and African Caribbean race on primary care doctors' decision making about depression. Soc Sci Med 2014; 116:161-8. [DOI: 10.1016/j.socscimed.2014.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/24/2014] [Accepted: 07/03/2014] [Indexed: 01/22/2023]
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Janssen IM, Gerhardus A, Schröer-Günther MA, Scheibler F. A descriptive review on methods to prioritize outcomes in a health care context. Health Expect 2014; 18:1873-93. [PMID: 25156207 DOI: 10.1111/hex.12256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence synthesis has seen major methodological advances in reducing uncertainty and estimating the sizes of the effects. Much less is known about how to assess the relative value of different outcomes. OBJECTIVE To identify studies that assessed preferences for outcomes in health conditions. METHODS SEARCH STRATEGY we searched MEDLINE, EMBASE, PsycINFO and the Cochrane Library in February 2014. INCLUSION CRITERIA eligible studies investigated preferences of patients, family members, the general population or healthcare professionals for health outcomes. The intention of this review was to include studies which focus on theoretical alternatives; studies which assessed preferences for distinct treatments were excluded. DATA EXTRACTION study characteristics as study objective, health condition, participants, elicitation method, and outcomes assessed in the study were extracted. MAIN RESULTS One hundred and twenty-four studies were identified and categorized into four groups: (1) multi criteria decision analysis (MCDA) (n = 71), (2) rating or ranking (n = 25), (3) utility eliciting (n = 5) and (4) studies comparing different methods (n = 23). The number of outcomes assessed by method group varied. The comparison of different methods or subgroups within one study often resulted in different hierarchies of outcomes. CONCLUSIONS A dominant method most suitable for application in evidence syntheses was not identified. As preferences of patients differ from those of other stakeholders (especially medical professionals), the choice of the group to be questioned is consequential. Further research needs to focus on validity and applicability of the identified methods.
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Affiliation(s)
- Inger M Janssen
- Department of Epidemiology & International Public Health, University of Bielefeld, Bielefeld, Germany.,Department of Health Information, Institute for Quality and Efficiency in Healthcare (IQWiG), Köln, Germany
| | - Ansgar Gerhardus
- Department of Health Services Research, Institute for Public Health and Nursing Science, University of Bremen, Bremen, Germany
| | - Milly A Schröer-Günther
- Department of Non-Drug Interventions, Institute for Quality and Efficiency in Healthcare (IQWiG), Köln, Germany
| | - Fülöp Scheibler
- Department of Non-Drug Interventions, Institute for Quality and Efficiency in Healthcare (IQWiG), Köln, Germany
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Tran AN, Ornelas IJ, Kim M, Perez G, Green M, Lyn MJ, Corbie-Smith G. Results from a pilot promotora program to reduce depression and stress among immigrant Latinas. Health Promot Pract 2014; 15:365-72. [PMID: 24334543 PMCID: PMC4172319 DOI: 10.1177/1524839913511635] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The stressful experiences that Latino immigrants face throughout the migration process to the United States put them at increased risk for poor mental health. Latinas are at heightened risk due to stigma, limited access to mental health resources, domestic violence, and gender role expectations. In addition, for those who live in new immigrant settlement areas, such as the Southeast, these disparities are magnified by even fewer culturally appropriate services and limited social support. This study evaluates the impact of ALMA (Amigas Latinas Motivando el Alma/Latina Friends Motivating the Soul), a pilot promotora intervention offered in three North Carolina counties to improve mental health among Latinas by offering coping skills training. The intervention trained community-based promotoras to conduct outreach to Latina women in their social network (compañeras). Using a pre-post test design, we assessed the mental health outcomes of compañeras. Compañeras improved on the following outcomes: depressive symptoms, attitudes of depression treatment, perceived and acculturative stress, perceived social support, and positive coping responses. Our findings suggest that promotora interventions, such as ALMA, that focus on building self-care strategies can be valuable to reducing preclinical symptoms and addressing health care disparities that are exacerbated by unavailable or underused mental health services.
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Affiliation(s)
- Anh N. Tran
- Division of Community Health, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina
| | - India J. Ornelas
- Department of Health Services, University of Washington, Seattle, WA.
| | - Mimi Kim
- Biobehavioral Research on Health Disparities, Duke University Medical Center, Durham, North Carolina.
| | - Georgina Perez
- Division of Community Health, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Melissa Green
- Program on Health Disparities, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina.
| | - Michelle J. Lyn
- Division of Community Health, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Giselle Corbie-Smith
- Social Medicine and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Harper B, Dickson JM, Bramwell R. Experiences of young people in a 16-18 Mental Health Service. Child Adolesc Ment Health 2014; 19:90-96. [PMID: 32878383 DOI: 10.1111/camh.12024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND 16-18-year-old young people experience a relatively high incidence of mental health problems but there is a paucity of research on their experience of mental health services (MHS). METHOD To gain understanding of young people's experiences of 16-18 MHS, we used qualitative Interpretative Phenomenological Analysis. Ten young people in two 16-18 MHS were interviewed about experiences of using MHS. RESULTS Five superordinate themes emerged from the data analysis, 'Power Differentials', 'Parental Involvement', 'Developmentally Attuned Services', 'Developing Self-Expression', 'Continuity and Loss of Relationships'. CONCLUSIONS Respondents valued developmentally appropriate MHS and emphasised the value of continuity in therapeutic relationships.
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Affiliation(s)
- Ben Harper
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Joanne M Dickson
- University Of Liverpool, Institute of Psychology, Health and Society, Liverpool, UK
| | - Ros Bramwell
- Psychology Department, University of Chester, Chester, CH1 4BJ, UK
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Burnett-Zeigler I, Kim HM, Chiang C, Kavanagh J, Zivin K, Rockefeller K, Sirey JA, Kales HC. The association between race and gender, treatment attitudes, and antidepressant treatment adherence. Int J Geriatr Psychiatry 2014; 29:169-77. [PMID: 23801324 DOI: 10.1002/gps.3984] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 04/17/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We examined the associations between treatment attitudes and beliefs with race-gender differences in antidepressant adherence. METHODS Subjects (n = 186) were African-American and White subjects aged ≥60 years, diagnosed with clinically significant depression, and had a new outpatient primary care recommendation for antidepressant treatment. Antidepressant adherence was assessed using the Brief Medication Questionnaire. Attitudes and beliefs were assessed using the Patients Attitudes Toward and Ratings of Care for Depression, two items rating perceived medication importance, and a modified version of the Stigma Scale for Receiving Psychological Help. RESULTS African-American men and women had significantly greater concerns about antidepressants and significantly less understanding about treatment than White women. African-American men had significantly more negative attitudes toward healthcare providers than African-American and White women. African-American women were more likely than White men and women to endorse a medication other than their antidepressant as most important. Whereas some race-gender differences were found in personal spirituality, no group differences were found in perceived stigma. In a logistic regression model adjusted for key baseline variables, White women were significantly more adherent to antidepressants than African-American women (OR = 3.05, 95% CI = 1.06-8.81). Fewer concerns about antidepressants and indicating the antidepressant as the most important medication were both significantly associated with adherence. After including either of these two variables, the adherence difference between White women and African-American women was no longer significant (OR = 2.56, 95% CI = 0.84-7.80). CONCLUSIONS Concerns about antidepressants and the importance of antidepressant medication are associated with adherence and are potentially modifiable through improved patient-provider communication, psycho-education, and therapeutic interventions.
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Affiliation(s)
- Inger Burnett-Zeigler
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wittink MN, Morales KH, Cary M, Gallo JJ, Bartels SJ. Towards personalizing treatment for depression : developing treatment values markers. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 6:35-43. [PMID: 23420133 DOI: 10.1007/s40271-013-0003-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While 'personalized medicine' commonly refers to genetic markers or profiles associated with pharmacological treatment response, tailoring treatments to patient preferences and values is equally important. OBJECTIVE To describe and demonstrate a method to develop 'values markers,' or profiles based on the relative importance of attributes of depression treatment. STUDY DESIGN Discrete choice analysis was used to assess individuals' relative preferences for features of depression treatment. Preference profiles were developed using latent profile analysis. PATIENTS OR OTHER PARTICIPANTS Eighty-six adults participating in an internet-based discrete choice questionnaire. MAIN OUTCOME MEASURE Participants were presented with two depression scenarios representing mild and severe depression. For each scenario, they were asked to compare 18 choice sets based on the type of medication side effect (nausea, dizziness, and sexual dysfunction) and severity (mild, moderate, and severe); and for counseling frequency (once per week or every other week) and provider setting (the office of a mental health professional, primary care doctor, or spiritual counselor). RESULTS Three profiles were identified: profile 1 was associated with a preference for counseling and an avoidance of medication side effects; profile 2 with an avoidance of strong medication side effects and for receiving counseling in medical settings; and profile 3 with a preference for medication over counseling. When presented with a severe depression scenario, there was a higher prevalence for profile 1 and patients were more likely to prefer mental health over primary care and spiritual settings. CONCLUSIONS Values markers may provide a foundation for personalized medicine, and reflect current initiatives emphasizing patient-centered care. Next steps should assess whether values markers are predictive of treatment initiation and adherence.
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Affiliation(s)
- Marsha N Wittink
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
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22
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Nicolaidis C, Wahab S, Trimble J, Mejia A, Mitchell SR, Raymaker D, Thomas MJ, Timmons V, Waters AS. The Interconnections Project: development and evaluation of a community-based depression program for African American violence survivors. J Gen Intern Med 2013; 28:530-8. [PMID: 23150070 PMCID: PMC3599026 DOI: 10.1007/s11606-012-2270-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 07/02/2012] [Accepted: 10/12/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multi-faceted depression care programs based within the healthcare system have been found to be effective, but may not fully address the needs of African American Intimate Partner Violence (IPV) survivors, many of whom are not seeking depression care in healthcare settings. OBJECTIVES To develop and evaluate a multifaceted, community-based depression care program (the Interconnections Project) for African American women with a history of IPV. METHODS We used a community-based participatory research (CBPR) approach to develop, implement, and evaluate the intervention. Participants were African American women who had current depressive symptoms and a lifetime history of IPV. They participated in a 6-month intervention where a peer advocate provided education, skills training, and case management services, and used Motivational Interviewing to support self-management behaviors. We conducted pre-intervention and post-intervention assessments using quantitative and qualitative data. RESULTS Fifty-nine women participated, with 92 % attending any sessions and 51 % attending at least 6 h of intervention activities. Intervention changes made to better accommodate participants' unpredictable schedules improved participation rates. Participants noted high levels of satisfaction with the program. There were significant improvements in depression severity (PHQ-9 13.9 to 7.9, p < 0.001), self-efficacy, self-management behaviors, and self-esteem (all p < 0.001), but no increase in use of antidepressants. Common themes related to why the program was helpful included that the program was by and for African American women, that it fostered trust, and that it taught self-management strategies with practical, lasting value. CONCLUSION Culturally specific, community-based interventions led by peer advocates may be a promising way to help African American IPV survivors effectively address depression.
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Affiliation(s)
- Christina Nicolaidis
- Division of General Internal Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
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Van Voorhees BW, Watson N, Bridges JFP, Fogel J, Galas J, Kramer C, Connery M, McGill A, Marko M, Cardenas A, Landsback J, Dmochowska K, Kuwabara SA, Ellis J, Prochaska M, Bell C. Development and pilot study of a marketing strategy for primary care/internet-based depression prevention intervention for adolescents (the CATCH-IT intervention). PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 12. [PMID: 20944776 DOI: 10.4088/pcc.09m00791blu] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 05/11/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adolescent depression is both common and burdensome, and while evidence-based strategies have been developed to prevent adolescent depression, participation in such interventions remains extremely low, with less than 3% of at-risk individuals participating. To promote participation in evidence-based preventive strategies, a rigorous marketing strategy is needed to translate research into practice. OBJECTIVE To develop and pilot a rigorous marketing strategy for engaging at-risk individuals with an Internet-based depression prevention intervention in primary care targeting key attitudes and beliefs. METHOD A marketing design group was constituted to develop a marketing strategy based on the principles of targeting, positioning/competitor analysis, decision analysis, and promotion/distribution and incorporating contemporary models of behavior change. We evaluated the formative quality of the intervention and observed the fielding experience for prevention using a pilot study (observational) design. RESULTS The marketing plan focused on "resiliency building" rather than "depression intervention" and was relayed by office staff and the Internet site. Twelve practices successfully implemented the intervention and recruited a diverse sample of adolescents with > 30% of all those with positive screens and > 80% of those eligible after phone assessment enrolling in the study with a cost of $58 per enrollee. Adolescent motivation for depression prevention (1-10 scale) increased from a baseline mean value of 7.45 (SD = 2.05) to 8.07 poststudy (SD = 1.33) (P = .048). CONCLUSIONS Marketing strategies for preventive interventions for mental disorders can be developed and successfully introduced and marketed in primary care.
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Cooper LA, Ghods Dinoso BK, Ford DE, Roter DL, Primm AB, Larson SM, Gill JM, Noronha GJ, Shaya EK, Wang NY. Comparative effectiveness of standard versus patient-centered collaborative care interventions for depression among African Americans in primary care settings: the BRIDGE Study. Health Serv Res 2012; 48:150-74. [PMID: 22716199 DOI: 10.1111/j.1475-6773.2012.01435.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of standard and patient-centered, culturally tailored collaborative care (CC) interventions for African American patients with major depressive disorder (MDD) over 12 months of follow-up. DATA SOURCES/STUDY SETTING Twenty-seven primary care clinicians and 132 African American patients with MDD in urban community-based practices in Maryland and Delaware. STUDY DESIGN Cluster randomized trial with patient-level, intent-to-treat analyses. DATA COLLECTION/EXTRACTION METHODS Patients completed screener and baseline, 6-, 12-, and 18-month interviews to assess depression severity, mental health functioning, health service utilization, and patient ratings of care. PRINCIPAL FINDINGS Patients in both interventions showed statistically significant improvements over 12 months. Compared with standard, patient-centered CC patients had similar reductions in depression symptom levels (-2.41 points; 95 percent confidence interval (CI), -7.7, 2.9), improvement in mental health functioning scores (+3.0 points; 95 percent CI, -2.2, 8.3), and odds of rating their clinician as participatory (OR, 1.48, 95 percent CI, 0.53, 4.17). Treatment rates increased among standard (OR = 1.8, 95 percent CI 1.0, 3.2), but not patient-centered (OR = 1.0, 95 percent CI 0.6, 1.8) CC patients. However, patient-centered CC patients rated their care manager as more helpful at identifying their concerns (OR, 3.00; 95 percent CI, 1.23, 7.30) and helping them adhere to treatment (OR, 2.60; 95 percent CI, 1.11, 6.08). CONCLUSIONS Patient-centered and standard CC approaches to depression care showed similar improvements in clinical outcomes for African Americans with depression; standard CC resulted in higher rates of treatment, and patient-centered CC resulted in better ratings of care.
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Affiliation(s)
- Lisa A Cooper
- Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Alderson SL, Foy R, Glidewell L, McLintock K, House A. How patients understand depression associated with chronic physical disease--a systematic review. BMC FAMILY PRACTICE 2012; 13:41. [PMID: 22640234 PMCID: PMC3439302 DOI: 10.1186/1471-2296-13-41] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 04/12/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Clinicians are encouraged to screen people with chronic physical illness for depression. Screening alone may not improve outcomes, especially if the process is incompatible with patient beliefs. The aim of this research is to understand people's beliefs about depression, particularly in the presence of chronic physical disease. METHODS A mixed method systematic review involving a thematic analysis of qualitative studies and quantitative studies of beliefs held by people with current depressive symptoms. MEDLINE, EMBASE, PSYCHINFO, CINAHL, BIOSIS, Web of Science, The Cochrane Library, UKCRN portfolio, National Research Register Archive, Clinicaltrials.gov and OpenSIGLE were searched from database inception to 31st December 2010. A narrative synthesis of qualitative and quantitative data, based initially upon illness representations and extended to include other themes not compatible with that framework. RESULTS A range of clinically relevant beliefs was identified from 65 studies including the difficulty in labeling depression, complex causal factors instead of the biological model, the roles of different treatments and negative views about the consequences of depression. We found other important themes less related to ideas about illness: the existence of a self-sustaining 'depression spiral'; depression as an existential state; the ambiguous status of suicidal thinking; and the role of stigma and blame in depression. CONCLUSIONS Approaches to detection of depression in physical illness need to be receptive to the range of beliefs held by patients. Patient beliefs have implications for engagement with depression screening.
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Affiliation(s)
| | - Robbie Foy
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Liz Glidewell
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kate McLintock
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Allan House
- Institute of Health Sciences, University of Leeds, Leeds, UK
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Elwy AR, Yeh J, Worcester J, Eisen SV. An illness perception model of primary care patients' help seeking for depression. QUALITATIVE HEALTH RESEARCH 2011; 21:1495-1507. [PMID: 21715607 DOI: 10.1177/1049732311413781] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many people with depression recognize their symptoms as depression, but fail to seek treatment for a number of years. We aimed to explore the reasons for this. Thirty primary care patients who screened positive for depression participated in semistructured, face-to-face interviews. Transcripts were analyzed using grounded thematic analysis. Patients who sought depression treatment emphasized their understanding of depression, their belief that treatment would work, and the negative consequences that would ensue if they did not seek treatment. Patients who did not seek treatment emphasized that treatment would not be effective, thought that depression would not last very long, and believed that depression did not affect their everyday lives. Patients' illness perceptions of depression were represented by and organized using the framework of the Self-Regulation Model of Illness Behavior. This model might be useful for planning patient activation intervention studies to increase the uptake of depression treatment in primary care.
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Affiliation(s)
- A Rani Elwy
- Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA 01730, USA.
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Mitchell AJ, Vahabzadeh A, Magruder K. Screening for distress and depression in cancer settings: 10 lessons from 40 years of primary-care research. Psychooncology 2011; 20:572-84. [PMID: 21442689 DOI: 10.1002/pon.1943] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 01/10/2011] [Accepted: 01/25/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE There has been at least 40 years of active research on screening for depression and distress in primary care. Both successes and failures have been documented. The purpose of this focussed narrative review was to summarise this research and present the key lessons for clinicians and researchers working in psychosocial oncology. METHODS We searched for studies assessing the utility of screening in primary care in seven electronic bibliographic databases (CENTRAL, CINAHL, Embase, HMIC, Medline, PsycINFO, Web of Knowledge) from inception to December 2010. Results were reviewed and summarised into key areas. RESULTS We found that research could be distilled into the following key learning points. (1) Primary care is an important partner in psychosocial care. (2) Both over and under detection are problematic. (3) Barriers to identification involve patient and clinician factors. (4) Acceptability of screening is critical to implementation. (5) Underserved groups need special attention in screening. (6) Patient-clinician trust is an important modifiable variable. (7) Greater contact influences detection. (8) Clinician confidence/skills influence screening success and subsequent action. (9) Training may improve confidence but effects upon long-term outcomes are modest. (10) Screening is generally ineffective without aftercare. CONCLUSIONS Primary care has shown largely what does not work in relation to screening. Namely relying on clinicians' unassisted judgement without infrastructural support, using over-complex scales with low acceptability, looking for depression alone, using screening without linked treatment, treating in the absence of follow-up and failing to engage patients in their own care. These pitfalls can and should be avoided in psychosocial oncology.
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Depression treatment preferences of Hispanic individuals: exploring the influence of ethnicity, language, and explanatory models. J Am Board Fam Med 2011; 24:39-50. [PMID: 21209343 PMCID: PMC3061814 DOI: 10.3122/jabfm.2011.01.100118] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE there is uncertainty regarding Hispanic individuals' depression treatment preferences, particularly regarding antidepressant medication, the most available primary care option. We assessed whether this uncertainty reflected heterogeneity among subgroups of Hispanic persons and investigated possible mechanisms. Specifically, we examined factors associated with medication preferences in non-Hispanic white and Spanish-speaking and English-speaking Hispanic persons. METHODS we analyzed data from a follow-up telephone interview of 839 non-Hispanic white and 139 Hispanic respondents originally surveyed via the 2008 California Behavioral Risk Factor Surveillance System. Measures included treatment preferences (for treatment plans including vs not including antidepressants); depression history and current symptoms; sociodemographics; and psychological measures. RESULTS compared with non-Hispanic white respondents (adjusting for age, sex, history of depression diagnosis, and current depression symptoms), Spanish-speaking Hispanic (adjusted odds ratio [AOR] 0.41; 95% CI, 0.19-0.90) but not English-speaking Hispanic (AOR, 1.18; 95% CI, 0.60-2.33) respondents had a lower preference for antidepressant inclusive options. Endorsing a biomedical explanation of depression was associated with a preference for antidepressant inclusive options (AOR, 4.76; 95% CI, 3.13-7.14) for all respondents and accounted for the effect of Spanish-language interview. Accounting for other factors did not change these relationships, although older age and history of depression diagnosis remained significant predictors of antidepressant inclusive treatment preference for all respondents. CONCLUSIONS Spanish-language interview and less belief in a biomedical explanation for depression were associated with Hispanic respondents' lower preferences for pharmacologic treatment of depression; ethnicity was not. Understanding treatment preferences and illness beliefs could help optimize depression treatment in primary care.
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Norton JL, Pommié C, Cogneau J, Haddad M, Ritchie KA, Mann AH. Beliefs and attitudes of French family practitioners toward depression: the impact of training in mental health. Int J Psychiatry Med 2011; 41:107-22. [PMID: 21675343 PMCID: PMC3596352 DOI: 10.2190/pm.41.2.a] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study, in a sample of French Family Practitioners (FPs), beliefs and attitudes toward depression and how they vary according to training received in mental health. METHODS The Depression Attitude Questionnaire (DAQ) was completed by 468 FPs from all regions of France, recruited by pharmaceutical company representatives to attend focus groups on the management of depression in general practice. RESULTS A three-factor model was derived from the DAQ, accounting for 37.7% of the total variance. The correlations between individual items of each component varied from 0.4 to 0.65, with an overall internal consistency of 0.47 (Cronbach's alpha). FPs had an overall neutral position on component 1, professional ease, a positive view on the origins of depression and its amenability to change (component 2), and a belief in the necessity of medication and the benefit of antidepressant therapy (component 3). Training in mental health, specifically through continuing medical education and postgraduate psychiatric hospital training, was significantly and positively associated with both professional ease and a medication approach to treating depression. CONCLUSION This study is the first description of the beliefs and attitudes of French FPs toward depression using a standardized measure, the DAQ, despite the instrument's limited psychometric properties. It shows the positive effect of training in mental health on attitudes toward depression.
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Affiliation(s)
- Joanna L. Norton
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière 39 AV Charles Flahault BP 34493 -Pav 42 Calixte Cavalier 34093 CEDEX 5 Montpellier,FR,* Correspondence should be addressed to: Joanna Norton
| | - Christelle Pommié
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière 39 AV Charles Flahault BP 34493 -Pav 42 Calixte Cavalier 34093 CEDEX 5 Montpellier,FR
| | - Joël Cogneau
- IRMG, Institut de Recherche en Médecine Générale
Institut de recherche en médecine générale105 rue de Javel 75015 Paris,FR
| | - Mark Haddad
- Health Services and Population Research Department
Institute of psychiatryNIHR Biomedical Research CentreKings CollegeLondon SE5 8AF,GB
| | - Karen A. Ritchie
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière 39 AV Charles Flahault BP 34493 -Pav 42 Calixte Cavalier 34093 CEDEX 5 Montpellier,FR
| | - Anthony H. Mann
- Health Services and Population Research Department
Institute of psychiatryNIHR Biomedical Research CentreKings CollegeLondon SE5 8AF,GB
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Battle CL, Uebelacker L, Friedman MA, Cardemil EV, Beevers CG, Miller IW. Treatment goals of depressed outpatients: a qualitative investigation of goals identified by participants in a depression treatment trial. J Psychiatr Pract 2010; 16:425-30. [PMID: 21107149 PMCID: PMC4070877 DOI: 10.1097/01.pra.0000390763.57946.93] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Treatment goals and preferences of depressed patients are important, but they are rarely empirically studied. Although clinicians are likely to discuss goals with individual patients, research that clarifies overall patterns in the treatment goals of depressed patients could be useful in informing new interventions for depression. Such research could also potentially help address problems such as poor adherence and psychotherapy drop-out. In this preliminary qualitative investigation, we examined treatment goals established by depressed outpatients in the context of a trial of behaviorally oriented psychotherapy. The treatment goals that were most commonly articulated included improving social and family relationships, increasing physical health behaviors, finding a job, and organizing one's home. These results underscore the fact that, in addition to improvement in the symptoms of depression, functional improvements are viewed as key treatment goals by depressed individuals.
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Affiliation(s)
- Cynthia L Battle
- Warren Alpert Medical School of Brown University and Butler Hospital, Providence, RI 02906, USA.
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Wittink MN, Cary M, TenHave T, Baron J, Gallo JJ. Towards Patient-Centered Care for Depression. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2010. [DOI: 10.2165/11530660-000000000-00000] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Non-adherence with psychotropic medications in the general population. Soc Psychiatry Psychiatr Epidemiol 2010; 45:47-56. [PMID: 19347238 DOI: 10.1007/s00127-009-0041-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 03/13/2009] [Indexed: 01/05/2023]
Abstract
BACKGROUND Non-adherence with medications is a general medical issue that has received much attention. However, the majority of studies have been on various clinical populations and the relevance of their results to the general population is unknown. In this study, we sought to determine the degree of non-adherence with antidepressants, antipsychotics, anxiolytics, mood stabilizers and sedative hypnotics, and to determine the reasons for non-adherence, in the general population of Canada. METHODS We used data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), conducted in 2002 (n = 36,984 adults), to produce population-based estimates of the degree of reported non-adherence with psychotropic medications and the reasons for non-adherence. RESULTS The number of individuals taking psychotropic medications was 6,201. The prevalence of antipsychotic use over the last 12 months was estimated at 0.4% (95% CI 0.3-0.4). The corresponding estimates for sedative-hypnotics, anxiolytics, mood stabilizers and antidepressants were 10.2% (95% CI 9.8-10.7), 5.5% (95% CI 5.2-5.8), 1.1% (1.0-1.3) and 5.8% (95% CI 5.5-6.2), respectively. Non-adherence was estimated to be 34.6% (95% CI 25.5-44.9) for antipsychotics, 34.7% (95% CI 32.2-37.4) for sedative-hypnotics, 38.1% (95% CI 35.0-41.4) for anxiolytics, 44.9% (95% CI 38.1-51.9) for mood stabilizers and 45.9% (95% CI 43.1-48.7) for antidepressants. The degree of non-adherence decreased with age for antidepressants and anxiolytics. Forgetting was the main reported reason for non-adherence, but its degree varied with medication class. The proportion of respondents that reported forgetting as a reason was 36.3% (95% CI 32.0-40.8) for sedative-hypnotics, 46.7% (95% CI 41.3-52.2) for anxiolytics, 72.7% (95% CI 55.5-85.0) for antipsychotics, 74.2% (95% CI 64.0-82.3) for mood stabilizers and 74.5% (95% CI 70.7-77.9) for antidepressants. The degree of non-adherence and the frequency of forgetting were not associated with the level of interference by the associated condition with usual activities. The majority of these estimates were also not impacted by educational status, employment status, rural/urban residence, income or the presence of a comorbid physical condition. CONCLUSION A high frequency of non-adherence was found with all five classes of psychotropic medication. Both the frequency of reported non-adherence and the reasons reported for it differ according to the medication. However, the degree of non-adherence was not affected by the level of interference of the associated condition.
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Wittink MN, Cary M, TenHave T, Baron J, Gallo JJ. TOWARDS PATIENT-CENTERED CARE FOR DEPRESSION: CONJOINT METHODS TO TAILOR TREATMENT BASED ON PREFERENCES. THE PATIENT 2010; 3:145-157. [PMID: 20671803 PMCID: PMC2910930 DOI: 10.2165/11530660] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND: Although antidepressants and counseling have been shown to be effective in treating patients with depression, non-treatment or under-treatment for depression is common especially among the elderly and minorities. Previous work on patient preferences has focused on medication versus counseling, but less is known about the value patients place on attributes of medication and counseling. OBJECTIVE: Conjoint analysis has been recognized as a valuable means of assessing patient treatment preferences. We examine how conjoint analysis be used to determine the relative importance of various attributes of depression treatment at the group level as well as to determine the range of individual-level relative preference weights for specific depression treatment attributes. In addition we use conjoint analysis to predict what modifications in treatment characteristics are associated with a change in the stated preferred alternative. STUDY DESIGN: 86 adults who participated in an internet-based panel responded to an on-line discrete choice task about depression treatment. Participants chose between medication and counseling based on choice sets presented first for a "mild depression" scenario and then for a "severe depression" scenario. Participants were given 18 choice sets which varied for medication based on type of side effect (nausea, dizziness, and sexual dysfunction) and severity of side effect (mild, moderate, and severe); and for counseling based on frequency of counseling sessions (once per week or every other week) and location of the sessions (mental health professional's office, primary care doctor's office or office of a spiritual counselor). RESULTS: Treatment type (counseling vs. medication) appeared to be more important in driving treatment choice than any specific attribute that was studied. Specifically counseling was preferred by most of the respondents. After treatment type, location of treatment and frequency of treatment were important considerations. Preferred attributes were similar in both the mild and severe depression scenarios. Side effect severity appeared to be most important in driving treatment choice as compared with the other attributes studied. Individual-level relative preferences for treatment type revealed a distribution that was roughly bimodal with 27 participants who had a strong preference for counseling and 14 respondents who had a strong preference for medication. CONCLUSION: Estimating individual-level preferences for treatment type allowed us to see the variability in preferences and determine which participants had a strong affinity for medication or counseling.
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Affiliation(s)
- Marsha N. Wittink
- Department of Family Medicine and Community Health, School of Medicine, University of Pennsylvania Philadelphia, Pennsylvania
| | - Mark Cary
- Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania Philadelphia, Pennsylvania
| | - Thomas TenHave
- Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania Philadelphia, Pennsylvania
| | - Jonathan Baron
- Department of Psychology, School of Arts and Sciences, University of Pennsylvania Philadelphia, Pennsylvania
| | - Joseph J. Gallo
- Department of Family Medicine and Community Health, School of Medicine, University of Pennsylvania Philadelphia, Pennsylvania
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Scheerder G, De Coster I, Van Audenhove C. Community pharmacists' attitude toward depression: A pilot study. Res Social Adm Pharm 2009; 5:242-52. [DOI: 10.1016/j.sapharm.2008.08.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 08/27/2008] [Accepted: 08/27/2008] [Indexed: 11/27/2022]
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Chakraborty K, Avasthi A, Kumar S, Grover S. Attitudes and beliefs of patients of first episode depression towards antidepressants and their adherence to treatment. Soc Psychiatry Psychiatr Epidemiol 2009; 44:482-8. [PMID: 19011717 DOI: 10.1007/s00127-008-0468-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 10/28/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Treatment adherence is influenced by factors like illness and patient characteristics, side effects, time taken to improve and the doctor-patient relationship. One of the important patient characteristic which has been reported to influence treatment adherence is their attitudes and beliefs towards medication. METHODOLOGY 50 subjects of first episode unipolar depression (except for severe depression with psychotic symptoms), aged 18-50 years, duration of depression of more than 1 month, with no comorbid psychiatric disorders and comorbid medical illnesses were assessed twice. At first intake, antidepressant compliance questionnaire (ADCQ) was administered. Second intake was done after 3 months for assessment of treatment adherence by using the questionnaire for assessment of treatment adherence. RESULTS On component-1 of ADCQ (doctor-patient relationship), 92% agreed that doctor gave sufficient time to listen to their problem, explained the causes of depression sufficiently, felt confident that antidepressants are suitable treatment of their depression. On component-2 (preserved autonomy), most (88%) subjects believed that antidepressants are difficult to stop when taken over a long period of time and can alter patient's personality. On component-3 (positive beliefs on anti-depressants), 72% of the subjects felt, fewer tablets could be taken on days one feels better. On component-4 (partner agreement), 96% of subjects reported their partner's positive attitude towards diagnosis and treatment. At the time of second assessment, majority of the subjects (88%) missed the antidepressant medication on less than 25% days in the last 3 months whereas only 4% of the subjects missed antidepressants for more than 75% of the days. Thirty eight percent of the subjects dropped out of the follow up at 3 months of first assessment. CONCLUSION Most of the patients value the doctor-patient relationship & their partners are also supportive regarding diagnosis and treatment of depression. However, most patients have erroneous beliefs regarding antidepressants per se which in turn influence the drug compliance.
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Affiliation(s)
- Kaustav Chakraborty
- Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Chung B, Jones L, Jones A, Corbett CE, Booker T, Wells KB, Collins B. Using community arts events to enhance collective efficacy and community engagement to address depression in an African American community. Am J Public Health 2008; 99:237-44. [PMID: 19059844 DOI: 10.2105/ajph.2008.141408] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We used community-partnered participatory research (CPPR) to measure collective efficacy and its role as a precursor of community engagement to improve depression care in the African American community of South Los Angeles. METHODS We collected survey data from participants at arts events sponsored by a CPPR workgroup. Both exploratory (photography exhibit; n = 747) and confirmatory (spoken word presentations; n = 104) structural equation models were developed to examine how knowledge and attitudes toward depression influenced community engagement. RESULTS In all models, collective efficacy to improve depression care independently predicted community engagement in terms of addressing depression (B = 0.64-0.97; P < .001). Social stigma was not significantly associated with collective efficacy or community engagement. In confirmatory analyses, exposure to spoken word presentations and previous exposure to CPPR initiatives increased perceived collective efficacy to improve depression care (B = 0.19-0.24; P < .05). CONCLUSIONS Enhancing collective efficacy to improve depression care may be a key component of increasing community engagement to address depression. CPPR events may also increase collective efficacy. Both collective efficacy and community engagement are relevant constructs in the South Los Angeles African American community.
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Prins MA, Verhaak PF, Bensing JM, van der Meer K. Health beliefs and perceived need for mental health care of anxiety and depression—The patients' perspective explored. Clin Psychol Rev 2008; 28:1038-58. [PMID: 18420323 DOI: 10.1016/j.cpr.2008.02.009] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 02/12/2008] [Accepted: 02/28/2008] [Indexed: 11/27/2022]
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Uebelacker LA, Battle CL, Friedman MA, Cardemil EV, Beevers CG, Miller IW. The importance of interpersonal treatment goals for depressed inpatients. J Nerv Ment Dis 2008; 196:217-22. [PMID: 18340257 DOI: 10.1097/nmd.0b013e3181663520] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Increased understanding of the treatment goals of depressed patients may lead to improved treatments and assist researchers and program evaluators in choosing clinically relevant outcome measures. To characterize patients' depression treatment goals, we interviewed hospitalized depressed patients about their treatment goals. Common responses included improving relationships, decreasing sadness or anxiety, and finding a job or improving job performance. On a written questionnaire, patients also ranked decreasing suicidal thoughts highly. These results suggest that for many severely depressed individuals, primary treatment goals include improvements in social and occupational functioning in addition to symptomatic improvement.
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Affiliation(s)
- Lisa A Uebelacker
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University and Butler Hospital, Providence, Rhode Island 02906, USA.
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The Influence of Depressive Symptoms on Clinician–Patient Communication Among Patients With Type 2 Diabetes. Med Care 2008; 46:257-65. [DOI: 10.1097/mlr.0b013e31816080e9] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Cepoiu M, McCusker J, Cole MG, Sewitch M, Belzile E, Ciampi A. Recognition of depression by non-psychiatric physicians--a systematic literature review and meta-analysis. J Gen Intern Med 2008; 23:25-36. [PMID: 17968628 PMCID: PMC2173927 DOI: 10.1007/s11606-007-0428-5] [Citation(s) in RCA: 255] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 09/29/2007] [Accepted: 10/04/2007] [Indexed: 01/04/2023]
Abstract
BACKGROUND Depression, with up to 11.9% prevalence in the general population, is a common disorder strongly associated with increased morbidity. The accuracy of non-psychiatric physicians in recognizing depression may influence the outcome of the illness, as unrecognized patients are not offered treatment for depression. OBJECTIVES To describe and quantitatively summarize the existing data on recognition of depression by non-psychiatric physicians. METHODS We searched the following databases: MEDLINE (1966-2005), Psych INFO (1967-2005) and CINAHL (1982-2005). To summarize data presented in the papers reviewed, we calculated the Summary receiver operating characteristic (ROC) and the summary sensitivity, specificity and odds ratios (ORs) of recognition, and their 95% confidence intervals using the random effects model. MEASUREMENTS AND MAIN RESULTS The summary sensitivity, specificity, and OR of recognition using the random effects model were: 36.4% (95% CI: 27.9-44.8), 83.7% (95% CI: 77.5-90.0), and 4.0 (95% CI: 3.2-4.9), respectively. We also calculated the Summary ROC. We performed a metaregression analysis, which showed that the method of documentation of recognition, the age of the sample, and the date of study publication have significant effect on the summary sensitivity and the odds of recognition, in the univariate model. Only the method of documentation had a significant effect on summary sensitivity, when the age of the sample and the date of publication were added to the model. CONCLUSION The accuracy of depression recognition by non-psychiatrist physicians is low. Further research should focus on developing standardized methods of documenting non-psychiatric physicians' recognition of depression.
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Affiliation(s)
- Monica Cepoiu
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montreal, QC, Canada.
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Hilty DM, McCarron RM, Ton H. Management of Mental Illness in Patients with Diabetes. Prim Care 2007; 34:713-30, v. [DOI: 10.1016/j.pop.2007.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Givens JL, Katz IR, Bellamy S, Holmes WC. Stigma and the acceptability of depression treatments among african americans and whites. J Gen Intern Med 2007; 22:1292-7. [PMID: 17610120 PMCID: PMC2219769 DOI: 10.1007/s11606-007-0276-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Revised: 04/05/2007] [Accepted: 06/19/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Stigma is associated with depression treatment, however, whether stigma differs between depression treatment modalities is not known, nor have racial differences in depression treatment stigma been fully explored. OBJECTIVE To measure stigma for four depression treatments and estimate its association with treatment acceptability for African Americans and whites. DESIGN Cross-sectional, anonymous mailed survey. PARTICIPANTS Four hundred and ninety African-American and white primary care patients. MEASUREMENTS The acceptability of four depression treatments (prescription medication, mental health counseling, herbal remedy, and spiritual counseling) was assessed using a vignette. Treatment-specific stigma was evaluated by asking whether participants would: (1) feel ashamed; (2) feel comfortable telling friends and family; (3) feel okay if people in their community knew; and (4) not want people at work to know about each depression treatment. Sociodemographics, depression history, and current depressive symptoms were measured. RESULTS Treatment-specific stigma was lower for herbal remedy than prescription medication or mental health counseling (p < .01). Whites had higher stigma than African Americans for all treatment modalities. In adjusted analyses, stigma relating to self [AOR 0.43 (0.20-0.95)] and friends and family [AOR 0.42 (0.21-0.88)] was associated with lower acceptability of mental health counseling. Stigma did not account for the lower acceptability of prescription medication among African Americans. CONCLUSIONS Treatment associated stigma significantly affects the acceptability of mental health counseling but not prescription medication. Efforts to improve depression treatment utilization might benefit from addressing concerns about stigma of mental health counseling.
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Affiliation(s)
- Jane L Givens
- Boston University Medical Center, Geriatrics Section, Boston, MA 02118-2393, USA.
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Givens JL, Houston TK, Van Voorhees BW, Ford DE, Cooper LA. Ethnicity and preferences for depression treatment. Gen Hosp Psychiatry 2007; 29:182-91. [PMID: 17484934 DOI: 10.1016/j.genhosppsych.2006.11.002] [Citation(s) in RCA: 213] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Revised: 11/09/2006] [Accepted: 11/09/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this work was to describe ethnic differences in attitudes toward depression, depression treatment, stigma and preferences for depression treatment (counseling vs. medication). METHOD This study used a cross-sectional Internet survey measuring treatment preference, stigma and attitudes toward depression. Depressive symptoms were measured with the Center for Epidemiological Studies Depression (CES-D) scale. Multivariable regression models adjusting for treatment attitudes and demographics estimated the independent effect of ethnicity on treatment preference. RESULTS A total of 78,753 persons with significant depressive symptoms (CES-D>22), including 3596 African Americans, 2794 Asians/Pacific Islanders and 3203 Hispanics, participated. Compared to whites, African Americans, Asians/Pacific Islanders and Hispanics were more likely to prefer counseling to medications [odds ratio (OR)=2.6, 95% confidence interval (95% CI)=2.4-2.8; OR=2.5, 95% CI=2.2-2.7; and OR=1.8, 95% CI=1.7-2.0, respectively]. Ethnic minorities were less likely to believe that medications were effective and that depression was biologically based, but were more likely to believe that antidepressants were addictive and that counseling and prayer were effective in treating depression. Attitudes and beliefs somewhat attenuated the association between ethnicity and treatment preference in adjusted analyses. CONCLUSION Racial and ethnic minorities prefer counseling for depression treatment more than whites. Beliefs about the effects of antidepressants, prayer and counseling partially mediate preferences for depression treatment.
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Affiliation(s)
- Jane L Givens
- Geriatrics Division, Boston University Medical Center, Boston, MA 02118, USA.
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Abstract
OBJECTIVE To assess 5-year mental disorder recognition rates and determine the natural history of mental disorders in primary care. METHODS A prospective cohort of adults presenting to a primary care walk-in clinic with a physical symptom were evaluated at baseline (n = 500) and at 5 years (n = 387) for mental disorders with the Primary Care Evaluation of Mental Disorders (PRIME-MD). Additional measures included functional status (Medical Outcomes Study SF-6; MOS-SF6), Patient Health Questionnaire-15, Satisfaction (Rand-9), unmet expectations, and symptom outcome. Patients self-reported whether their disorder was diagnosed or treated at the 5-year follow-up. RESULTS At baseline, 29% of patients had a mental disorder (major depression: 8.4%, minor depression 10.4%, Panic disorder 1.4%, generalized anxiety disorder 2%, anxiety not otherwise specified (NOS) 11.4%); of these patients, 26% had more than one mental disorder. Over 5 years, 33% were recognized. Threshold disorders were more likely to be recognized (major depression 56%, panic 100%, generalized anxiety disorder 88%) than subthreshold disorders (minor depression 20%, anxiety NOS 25%). Correlates of recognition included having a threshold or multiple disorders; recognition was associated with greater likelihood of persistence. Most patients with subthreshold disorders at baseline had no disorder at 5 years and few progressed to threshold disorders (minor to major depression 12%, anxiety NOS to generalized anxiety or panic 8%). CONCLUSIONS Mental disorders are common and their recognition and treatment remain low. Subthreshold disorders have a better prognosis. Patients with threshold or multiple disorders, worse functioning or persistence of their disorder were more likely to be diagnosed.
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Affiliation(s)
- Jeffrey L Jackson
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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Cabassa LJ, Zayas LH. Latino immigrants' intentions to seek depression care. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2007; 77:231-242. [PMID: 17535121 PMCID: PMC3652401 DOI: 10.1037/0002-9432.77.2.231] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the role that illness perceptions, attitudes toward depression treatments, and subjective norms played in Latino immigrants' intentions to seek depression care. Ninety-five Latino immigrant patients were presented a vignette depicting an individual with major depression and interviewed about their intentions to seek care if confronted with a similar situation. Patients' preferences were to rely on informal sources of care first, and then turn to formal sources to cope with depression. Findings showed Latinos immigrants' help-seeking intentions for depression were a function of their views of depression, attitudes toward their doctors' interpersonal skills, and social norms related to seeking professional care after controlling for demographics, health insurance status, acculturation, clinical characteristics, perceived barriers to care, and past service use.
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Haddad M, Walters P, Tylee A. District nursing staff and depression: A psychometric evaluation of Depression Attitude Questionnaire findings. Int J Nurs Stud 2007; 44:447-56. [PMID: 16979641 DOI: 10.1016/j.ijnurstu.2006.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 06/22/2006] [Accepted: 07/13/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mental health problems such as depression are common in primary care settings and patients with chronic medical problems are at an increased risk. This co-morbidity suggests that district nursing services are particularly likely to encounter psychological problems in their patients. Mental health problems are poorly recognised and inadequately treated in primary care. In part this may be due to stigmatising views of mental illness, which negatively influence help-seeking and user experiences. Likewise providers' attitudes are likely to play a significant part in the management of such problems. OBJECTIVES The aims of this study were extend knowledge of district nursing staff attitudes to depression and explore the psychometric properties of a depression attitude measure used with this staff group. DESIGN AND SETTINGS The Depression Attitude Questionnaire (DAQ) was used within a postal questionnaire survey of district nursing services in three areas, Jersey (Channel Islands), Lewisham, and Hertfordshire. PARTICIPANTS All staff (community nurses, district nurses and home care staff) were contacted; 217 (66%) staff responded to the survey, and 189 (57%) completed the DAQ. RESULTS Three factors were derived from the DAQ accounting for 47% of the variance. The factor solution appeared stable and provided meaningful dimensions, however the internal consistency of the measure and of its derived subscales was low (Cronbach's alpha between 0.59 and 0.64). The factors were labelled pessimism about depression and its treatment, tendency to defer to specialists, and professional ease in working with depressed patients. Staff responses revealed generally optimistic views concerning depression treatment, strongly rejecting deterministic attitudes to this condition. CONCLUSIONS The DAQ has been widely employed to measure and compare attitudes of staff from various disciplines and specialisms. The current evaluation has provided a more detailed examination of its psychometric properties than previously available, but low internal consistency levels indicate further examination of this area is warranted.
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Affiliation(s)
- Mark Haddad
- Section of Psychiatric Nursing, King's College London, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, UK.
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Campbell SM, Gately C, Gask L. Identifying the patient perspective of the quality of mental healthcare for common chronic problems: a qualitative study. Chronic Illn 2007; 3:46-65. [PMID: 18072697 DOI: 10.1177/1742395307079193] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To identify which aspects of quality are important to individual patients with common chronic mild-to-moderate mental health problems presenting to general practice and the best method of involving patients with chronic mental health problems in the research process, and to contrast the relevance of a generic questionnaire developed previously with these individual patient narratives. METHODS Qualitative interviews with 16 patients in Chester and Manchester were subjected to thematic analysis. RESULTS Six key themes were identified in relation to the individual patient experience set against a generic patient experience: (1) the healthcare system provides a generic 'one size fits all' service, which is incompatible with an individual patient's experience and sense of being as an individual and that privileges medical over social care; (2) patients with mild-to-moderate mental health problems often have feelings of powerlessness and of being 'lost' in a system that is more responsive to severe and acute episodes of illness than to chronic morbidity; (3) patients often have unmet needs in relation to the distress of living with mild-to-moderate mental health problems; (4) there are substantial quality deficits in primary care for people with mild-to-moderate chronic mental health problems; (5) general practitioners are rated highly, and the attributes of a good general practitioner can be identified; patients also value continuity of care; (6) engaging people with common chronic mental health problems in the research/policy process requires generic assessment of quality using questionnaires supplemented with more in-depth methods, such as interviews and focus groups. Interviewees highlighted substantial quality deficits in service provision for people with chronic mental health problems. Involving patients with chronic mild-to-moderate mental health problems in the research/policy process requires multiple user involvement strategies, including questionnaires but supplemented with interviews and discussion groups. CONCLUSION Patients with common chronic mental health problems have a clear view about what constitutes quality general practice/practitioner care but highlighted quality deficits for people with chronic mental health conditions.
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Affiliation(s)
- Stephen M Campbell
- National Primary Care Research and Development Centre, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
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Cabassa LJ, Lester R, Zayas LH. "It's like being in a labyrinth:" Hispanic immigrants' perceptions of depression and attitudes toward treatments. J Immigr Minor Health 2007; 9:1-16. [PMID: 17001516 PMCID: PMC3160757 DOI: 10.1007/s10903-006-9010-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study aimed to describe Hispanic immigrants' perceptions of depression and attitudes toward treatments and to examine how demographics, acculturation, clinical factors, and past service use were associated with their perceptions and attitudes. A convenience sample of 95 Hispanic immigrant patients was presented a vignette depicting an individual with major depression. Structured interviews that included standardized instruments and open-ended questions were used to query patients about their views of depression and its treatments. Findings showed that Hispanic immigrants perceived depression as a serious condition caused by interpersonal and social factors. Consistent with existing literature, most patients endorsed positive attitudes toward depression treatments yet reported apprehensions toward antidepressants. Demographic factors, acculturation, depressive symptoms, and past mental health service use were related to patients' views of depression and attitudes toward care. This study emphasizes the need to incorporate Hispanic immigrants' perceptions and attitudes into depression treatments.
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Affiliation(s)
- Leopoldo J Cabassa
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA 90089-0411, USA.
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Kuwabara SA, Van Voorhees BW, Gollan JK, Alexander GC. A qualitative exploration of depression in emerging adulthood: disorder, development, and social context. Gen Hosp Psychiatry 2007; 29:317-24. [PMID: 17591508 PMCID: PMC2769013 DOI: 10.1016/j.genhosppsych.2007.04.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 04/04/2007] [Accepted: 04/09/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE One in four emerging adults will experience a depressive episode between the ages of 18-25. We examined the lived experience of emerging adults with a focus on their treatment seeking, development and the social context of their illness. METHOD In-depth interviews were conducted with 15 participants with major or minor depression. Interviews were recorded, transcribed verbatim and analyzed using established qualitative methods. RESULTS Emerging adults reported dynamic and complex interactions within and between thematic areas including identification as an individual with depression, interactions with the healthcare system, relationships with friends and family, and role transitions from childhood to adulthood. Depressed mood, concerns about self-identifying one's self as being depressed, the complexity of seeking care often without insurance or financial support, alienation from peers and family, and a sense of failure to achieve expected developmental milestones appeared to interact and exacerbate functional impairment. CONCLUSIONS Further research is needed to better understand and intervene upon pathways that lead to poor outcomes such as delayed milestones among emerging adults with depression. Health care providers should be conscious of the unique vulnerabilities posed by depressive disorders in this age group.
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Kilbourne AM, Switzer G, Hyman K, Crowley-Matoka M, Fine MJ. Advancing health disparities research within the health care system: a conceptual framework. Am J Public Health 2006; 96:2113-21. [PMID: 17077411 PMCID: PMC1698151 DOI: 10.2105/ajph.2005.077628] [Citation(s) in RCA: 477] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We provide a framework for health services-related researchers, practitioners, and policy makers to guide future health disparities research in areas ranging from detecting differences in health and health care to understanding the determinants that underlie disparities to ultimately designing interventions that reduce and eliminate these disparities. To do this, we identified potential selection biases and definitions of vulnerable groups when detecting disparities. The key factors to understanding disparities were multilevel determinants of health disparities, including individual beliefs and preferences, effective patient-provider communication; and the organizational culture of the health care system. We encourage interventions that yield generalizable data on their effectiveness and that promote further engagement of communities, providers, and policymakers to ultimately enhance the application and the impact of health disparities research.
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Affiliation(s)
- Amy M Kilbourne
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pa 15240, USA.
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